Early predictors of Epstein-Barr virus infection in patients with severe fever with thrombocytopenia syndrome.

BACKGROUND: Epstein-Barr virus (EBV) can be reactivated and proliferated with fatal outcome in immuno-compromised people, but the clinical consequences of EBV infection in patients with severe fever with thrombocytopenia syndrome (SFTS) remain uncertain. In this study, we investigated the infection rate, the influence and the early predictors of EBV infection in SFTS patients. METHODS: In this retrospective study, SFTS patients who were treated in the First Affiliated Hospital of Nanjing Medical University from May 2011 to August 2021 were enrolled and divided into infected and non-infected groups. We compared the demographic characteristics, clinical manifestations and signs, laboratory tests and prognosis, and explored the risk factors of EBV infection by receiver operating characteristic (ROC) curve and logistic regression. RESULTS: A total of 120 hospitalized SFTS patients with EBV-DNA testing were enrolled in this study. Patients with EBV infection had statistically significant higher mortality rate (32.0% vs. 11.43%, P = 0.005). Compared with the non-infected group, the EBV-infected group had higher levels of C-reactive protein (CRP), creatine-kinase (CK), fasting blood glucose (FBG), blood urea nitrogen (BUN), D-dimer, and CD56+ cell counts, lower levels of immunoglobulin G (IgG), IgM, complement 3 (C3), and C4. The proportion of patients with age ≥ 60 years and ferritin > 1500.0 ng/ml in the EBV-infected group was significantly higher than that in the non-infected group. The results of ROC analysis showed that the cut-off values of CRP, IgG, C3, C4, and CD56+ cell counts to predict EBV infection were 13.2 mg/l, 12.5 g/l, 1.1 g/l, 0.6 g/l, 0.3 g/l, and 94.0 cells/µl. Multivariable logistic analysis showed that age ≥ 60 years old, CRP > 13.2 mg/l, BUN > 5.4 mmol/l, ferritin > 1500.0 ng/ml, IgG < 12.5 g/l, IgM < 1.1 g/l, C4 < 0.3 g/l, and CD56+ cell counts > 94.0 cells/µl were the independent risk factors of EBV infection in SFTS patients. CONCLUSIONS: SFTS combined with EBV infection is associated with high morbidity and mortality. It is necessary to strengthen screening for EBV infection and its early predictive markers after admission in SFTS patients.

Distinct Brain Dynamic Functional Connectivity Patterns in Schizophrenia Patients With and Without Auditory Verbal Hallucinations.

Schizophrenia patients with auditory verbal hallucinations (AVHs) are diseased groups of serious psychosis with still unknown etiology. The aim of this research was to identify the neurophysiological correlates of auditory verbal hallucinations. Revealing the neural correlates of auditory hallucination is not merely of great clinical significance, but it is also quite essential to study the pathophysiological correlates of schizophrenia. In this study, 25 Schizophrenia patients with AVHs (AVHs group, 23.2 ± 5.35 years), 52 Schizophrenia patients without AVHs (non-AVHs group, 25.79 ± 5.63 years) and 28 healthy subjects (NC group, 26.14 ± 5.45 years) were enrolled. Dynamic functional connectivity was studied with a sliding-window method and functional connectivity states were then obtained with the k-means clustering algorithm in the three groups. We found that schizophrenia patients with AVHs were characterized by significant decreased static functional connectivity and enhanced variability of dynamic functional connectivity (non-parametric permutation test, Bonferroni correction, p < 0.05). In addition, the AVHs group also demonstrated increased number of brain states, suggesting brain dynamics enhanced in these patients compared with the non-AVHs group. Our findings suggested that there were abnormalities in the connection of brain language regions in auditory verbal hallucinations. It appears that the interruption of connectivity from the language region might be critical to the pathological basis of AVHs.

A Clinical Practice Guideline for the Emergency Management of Anaphylaxis (2020).

Background: For anaphylaxis, a life-threatening allergic reaction, the incidence rate was presented to have increased from the beginning of the 21st century. Underdiagnosis and undertreatment of anaphylaxis are public health concerns. Objective: This guideline aimed to provide high-quality and evidence-based recommendations for the emergency management of anaphylaxis. Method: The panel of health professionals from fifteen medical areas selected twenty-five clinical questions and formulated the recommendations with the supervision of four methodologists. We collected evidence by conducting systematic literature retrieval and using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: This guideline made twenty-five recommendations that covered the diagnosis, preparation, emergency treatment, and post-emergency management of anaphylaxis. We recommended the use of a set of adapted diagnostic criteria from the American National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network (NIAID/FAAN), and developed a severity grading system that classified anaphylaxis into four grades. We recommended epinephrine as the first-line treatment, with specific doses and routes of administration for different severity of anaphylaxis or different conditions. Proper dosage is critical in the administration of epinephrine, and the monitor is important in the IV administration. Though there was only very low or low-quality evidence supported the use of glucocorticoids and H1 antagonists, we still weakly recommended them as second-line medications. We could not make a well-directed recommendation regarding premedication for preventing anaphylaxis since it is difficult to weigh the concerns and potential effects. Conclusion: For the emergency management of anaphylaxis we conclude that: • NIAID/FAAN diagnostic criteria and the four-tier grading system should be used for the diagnosis • Prompt and proper administration of epinephrine is critical.

Relationship Between Proactive Personality and Job Performance of Chinese Nurses: The Mediating Role of Competency and Work Engagement.

Background: As one of the main participants in health care, nurses are esteemed an important driving force for the vigorous health care development. Studies report that nurses' proactive personality has positive effects on their job performance; however, this relationship acquires further understanding. Objective: A cross-sectional study was performed to explore the relationship between nurses' proactive personality and job performance; the mediating role of nurses' competency and work engagement in this relationship was also evaluated. Methods: The study was performed in a large third-degree general hospital in October 2019, Xi'an, PR, China. A sample of 246 nurses participated in this cross-sectional study. Proactive personality was assessed with the Proactive Personality Questionnaire (PPS), job performance was assessed by Heilman three-item measurements, nurse competence was estimated with Nurse Competency Scale (NCS), and work engagement was assessed with the Utrecht Work Engagement Scale (UWES). The structural equation model was used to test the main hypotheses. Results: Structural equation model analysis revealed that work engagement partially mediated the association between proactive personality and job performance. The serial two-mediator model which was used to explore the association between proactive personality and job performance through competency and work engagement, in sequence, was demonstrated. Conclusion: This study demonstrates that work engagement partially mediated the association between nurses' proactive personality and their job performance. The serial two-mediator model demonstrated that proactive personality was associated with job performance via competency and work engagement. This study also revealed the critical role of nursing managers in understanding the nurses' proactive personality, which would facilitate them to enhance the latter's competency and promote their work engagement. All these will in turn constantly improve the overall quality of nursing and advance professional development of nursing and benefits for patients.

ASPEN PLUS desulfurization simulations for the scrubber of a large-scale marine diesel engine: main scrubbing section's desulfurization share optimization and superiority confirmation for the seawater/seawater cascade-scrubbing solution.

Aiming at perfecting the proposed three-stage cascade-scrubbing desulfurization technology, ASPEN PLUS simulations of seawater/seawater cascade-scrubbing desulfurization for an exhaust gas scrubber designed for a 10-MW large-scale marine diesel engine were performed to fix a reasonable desulfurization share for the main scrubbing section. Accordingly, three typical desulfurization share setups of 80%, 85%, and 90% were compared under various operational conditions by varying the fuel-sulfur content, liquid/gas ratio, and seawater alkalinity. In complying with the desulfurization requirements of emission control areas, 85% was obtained as the optimal desulfurization share among the three setups. Again, under the selected 85% setup, the cascade-scrubbing desulfurization was numerically compared with the conventional once-through open-loop solution, so as to confirm the seawater-saving advantage of the cascade-scrubbing desulfurization technology used for the exhaust gas of large-scale marine diesels. At relatively higher sulfur content above 3.5%, the open-loop solution solely achieved the desulfurization requirements of non-emission control areas by using higher liquid/gas ratio levels of 6.5-8.0 L/Nm3, while fully failed to meet the much stricter requirements of emission control areas except the lowest 1.5% fuel-sulfur conditions. On the contrary, the cascade-scrubbing solution could meet the requirements of emission control areas under various fuel-sulfur content conditions and reduced the liquid/gas ratio by about 45%, in comparison to the open-loop solution.

PINK1/PRKN-dependent mitophagy in the burn injury model.

Burn injury leads to mitochondrial dysfunction and autophagy, also known as mitophagy. The alleviation of mitochondrial damage may be a potential method for the treatment of burn injury and complications. In this animal study, we analyzed the expression of mitochondrial damage- and mitophagy-related factors, specifically PINK1 and PRKN. The results showed mitochondria damage in the skin; compared with the normal control group, genes involved in the mitochondrial damage, such as Nrf-1, UQCRC2, CYC1, and NDUFA9, as well as in the mitophagy, including PINK1, PRKN, MFN1, and USP30, were differentially expressed. Furthermore, PINK1 interacted with PRKN and participated in mitophagy in the skin. In conclusion, our data reveal more about the mechanism underlying mitophagy in burns, providing a potential clinical treatment.

Low-NOx and High-Burnout Combustion Characteristics of a Cascade-Arch-Firing, W-Shaped Flame Furnace: Numerical Simulation on the Effect of Furnace Arch Configuration.

A cascade-arch-firing low-NOx and high-burnout configuration (CLHC) was proposed as a solution for the W-shaped flame furnace's incompatibility problem of strengthened low-NOx combustion and high burnout. Numerical simulations verified by industrial-size measurements of a 600 MWe W-shaped flame furnace were used to confirm the CLHC's low-NOx and high-burnout characteristics and evaluate its cascade-arch configuration effect on the gas/particle flow, coal combustion, and NOx formation. The furnace with the existing low-NOx combustion art showed NOx emissions of about 900 mg/m3 at 6% O2 and carbon in fly ash of about 5%. In applying CLHC as a replacement for the prior art, numerical simulations at typical cascade-arch configurations of CL = 1/5, 1/4, and 1/3 (CL signifying the ratio of the lower arch depth to the total arch depth) showed that as CL increased, both the flow field and combustion symmetry initially improved but then deteriorated. In conjunction with the improvement in both NOx emissions and burnout, the CL = 1/4 setting achieved the best furnace performance with NOx emissions 707 mg/m3 at 6% O2 and carbon in fly ash of 5.5%. In comparison with the prior low-NOx art, CLHC reduced further NOx emissions by 22% and almost maintains the burnout rate.

Myricetin ameliorated ischemia/reperfusion-induced brain endothelial permeability by improvement of eNOS uncoupling and activation eNOS/NO.

Disruption of the blood-brain barrier (BBB) has been considered as a major pathological change in stroke. eNOS/NO play a key role in maintain BBB function. Myricetin is one of the common flavones widely exists in food and fruit, show certain protective effect on the brain function. This experiment establishes oxygeneglucose deprivation and reoxygenation (OGD/R) brain cell model. The regulated effects of Myricetin on BBB function, eNOS/NO and eNOS uncoupling were evaluated. To investigate the molecular mechanism, Akt and Nrf2 inhibitor were also used. The result showed that Myricetin could significantly decreased the enhancement of endothelial permeability and inflammation in OGD/R model, in addition regulated eNOS/NO pathway. The regulate effect in endothelial permeability and eNOS activity by Myricetin were both decreased when combined with Akt inhibitor or Nrf2 inhibitor, and was abrogated when combined with Akt and Nrf2 inhibitor simultaneously. The regulated effect on eNOS uncoupling by Myricetin were abrogated when combined with Nrf2 inhibitor, but not with Akt inhibitor. In conclusion, Myricetin showed significant protect effect on ischemia/reperfusion-induced brain endothelial permeability, and related to simultaneously regulated Akt pathway and improvement of eNOS uncoupling through Nrf2 pathway.

Exogenous melatonin in the treatment of pain: a systematic review and meta-analysis.

Melatonin is an important hormone for regulating mammalian circadian biology and cellular homeostasis. Recent evidence has shown that melatonin exerts anti-nociception effects in both animals and humans. However, according to clinical trials, the anti-nociception effects of melatonin are still controversial. The aim of this meta-analysis was to investigate the anti-nociception effects of melatonin premedication. The primary outcome was the effects of melatonin on pain intensity. The secondary outcomes included the number of patients with analgesic requirements, total analgesic consumption, and brain-derived neurotrophic factor (BDNF) levels. In total, 19 studies were included in the current meta-analysis. The pooling data show that melatonin significantly decreased the pain intensity, as evidenced by the pain scores. Moreover, melatonin administration also reduced the proportion of patients with analgesic requirements and BDNF levels. However, the effects of melatonin on total analgesic consumption still require further confirmation. Collectively, the current meta-analysis supports the use of melatonin for anti-nociception.

Tumor thickness predicts long-term complete response of facial basal cell carcinomas in Asian skin types iv/v treated with methyl aminolaevulinate photodynamic therapy.

BACKGROUND: Basal cell carcinoma (BCC) responds well to topical photodynamic therapy (PDT), with high clearance rates of 72-100%, although the therapy showed limited effectiveness for lesions > 2 mm thick. Tumor thickness is thought to be associated with therapeutic response. OBJECTIVE: The purpose of this study was to investigate the efficacy, safety, and response depth of methyl aminolaevulinate (MAL) PDT for BCC. METHODS: After application of MAL emulsion, each lesion was irradiated with 633-nm red light (total dose: 339 J/cm(2)). Complete response (CR) rates were assessed by histological examination at 6, 12, and 24 months. RESULTS: Forty-seven patients (95 lesions) with skin type IV/V were enrolled. Overall CR rate at 24 months was 75.8%. Superficial BCC was more responsive than other subtypes. Tumor thickness beyond subtype was significantly associated with CR rate. Three response depths are proposed: absolute CR (<1.3 mm), relative response (1.3 -1.8 mm) and no response (>1.8 mm). Although the recurrence rate (24%) is higher than with conventional surgical excision, 90.3% of patients were satisfied with the cosmetic outcome. CONCLUSIONS: MAL-PDT offers a noninvasive effective treatment; however, it is not the first option for most BCCs, except inoperable cases. The tumor thickness, independent of subtype, is predictive of PDT response.

Long-term follow-up of in situ extramammary Paget's disease in Asian skin types IV/V treated with photodynamic therapy.

Photodynamic therapy is a potentially advantageous treatment for non-melanoma skin cancers. We evaluated the clinical response, recurrence and adverse events of photodynamic therapy for in situ extramammary Paget's disease in 14 male and 3 female Chinese patients with 21 lesions. Topical 20% 5-aminolevulinic acid was applied for 6 h. Each lesion was irradiated with 633 nm red light three times, 1 week apart, at a total dose of 339 J/cm2, followed by three assessments at 6, 12 and 24 months. Overall complete response (CR) rates were 52.4%, 42.9%, and 33.3% at 6, 12 and 24 months, respectively. The CR rate was significantly higher in scrotal lesions (66.6%) than in non-scrotal lesions (8.3%). The overall recurrence rate was 50%. The highest CR rate was for the lesions < 4 cm in diameter (62.5%), followed by those 4-8 cm (33.3%) and > 8 cm (0%). Most adverse events were well tolerated. In conclusion, photodynamic therapy for extramammary Paget's disease is not recommended as the first option except for scrotal cases or lesions < 4 cm in diameter.